Brief Answer: Both the conditions may co-exist. Detailed Answer: Hello, Thanks for posting your query. The recurrent pain in the knee and the foot that you are having can be due to rheumatoid arthritis. It can be diagnosed based on the clinical symptoms even if RA factor is negative. But since you started taking prednisolone and HCQS, the symptoms should have improved. The raised levels of uric acid in the blood will add to the inflammation of the joints. You need to start taking the medicine- Febuxostat to increase the uric acid excretion from the body to bring back the levels for an early recovery. I hope this answers your query. In case you have additional questions or doubts, you can forward them to me, and I shall be glad to help you out. Wishing you good health. Regards. Dr. Praveen Tayal.

---

Brief Answer: Continue Predisolone and start Febuxostat Detailed Answer: Hello, I have gone through all your reports in detail. The rise in Uric acid levels(not very high) is likely to be a cause of recurrent pains. I find that RA factor is undetectable in the report. The doctor would have diagnosed it as RA based on clinical criteria. Rheumatoid arthritis can also be a possible cause. As I said earlier, both of them can co-exist. You can start with Febuxostat and observe the response in two weeks. The dose of this medicine needs to be monitored regularly. Hence follow-ups are essential. Since Prednisolone alleviated your symptoms, you may continue with it. I would suggest that you redo the Serum Uric Acid levels again after two weeks. Hope my answer is helpful. If you do not have any clarifications, you can close the discussion and rate the answer. Wish you good health. Regards Dr. Praveen Tayal

---

Brief Answer: There is definitive cause for RA. Detailed Answer: Hello again Mr. XXXXXXX I understand your frustration. I will answer your specific queries in order, 1. The straightforward answer is "NO". Improvement with Prednisolone cannot judge whether it is RA or not. Most of your tests are negative, except some moderate elevation of ESR and increased total WBC counts. But these are not specific for RA. Rheumatoid arthritis is diagnosed with the help of a scoring system called 2010 ACR Diagnostic Criteria which takes into account the clinic findings, lab findings, and patient self reported activity levels. There are many other tests that can be done to look for changes of rheumatoid arthritis like X-ray, MRI scan, Joint fluid aspiration, Sinovial biopsy to name a few, which can show the degenerative changes that may be present if it is rheumatoid arthritis. RA has no specific cause yet identified, it is a degenerative systemic disorder that may or may not have serological markers positive. This means, there two types of RA, 1. Seropositive RA, 2. Seronegative RA. You might have second variant and your doctor has judged it with clinical criteria. I don't find your uric acid levels to be elevated and concerning. The lab range which is given in the side clearly says for males the reference range is 3.5-7.2, your level is 6.5, which is just high normal. 2. Symptomatic improvement after prednisolone does not indicate that the condition is rheumatoid arthritis, it simply means that the inflammatory process which was going on is under control due to prednisolone. 3. Since you are very happy about Prednisone, you need not start on Febuxostat for now. I was only talking about trial therapy with Febuxostat for two weeks in my previous reply and retest serum uric acid levels. I was hoping if Febuxostat improves the condition. Since you are benefiting from prednisolone and HCQ, there is no need to start Febuxostat. Continue with prednisolone as per your rheumatologist's advice. It is only one month now and small dose. On follow up your rheumatologist will take a decision about tapering. You can gradually taper it off. I sincerely hope I have addressed all your concerns, however if you need further clarifications, you are most welcome to ask me for the same. In case you don't have any more questions and are satisfied, please close the query and review the answer. Wishing you good health. Best regards,

---